怀孕前3个月的哮喘患者吸入糖皮质激素致胎儿先天畸形的危险度分析
2007/06/27
孕期哮喘患者用药安全问题一直是学者们关注的课题。最近Lucie Blais等人在Thorax上发表了一篇研究,旨在评价怀孕前3个月的哮喘患者吸入不同剂量糖皮质激素导致胎儿畸形的危险度。他们采用两阶段抽样队列研究，将1990～2000年间来自加拿大官方数据库的4561名哮喘孕妇患者纳入研究范围。
结果发现，怀孕前3个月的哮喘患者，使用不同剂量吸入激素并没有显著增加胎儿先天畸形发生率，但需要警惕大剂量吸入激素可能增加主要先天畸形发生率。值得一提的是，他们的研究中还发现，怀孕前3个月使用中等剂量吸入激素的哮喘患者较未使用吸入激素的哮喘孕妇患者生产先天畸形儿的机率更低。
由此，结合以往的文献报道,他们的研究进一步证实了孕期使用吸入激素的安全性，但尚需进一步探讨大剂量吸入激素是否能够增加主要先天畸形的发生率。
（毛辉 成都,四川大学华西医院呼吸科 610041 摘译）
Use of inhaled corticosteroid s during the first trimester of pregnancy and the risk of congenital malformations among women with asthma
Lucie Blais1,3, Marie-France Beauchesne2,3, évelyne Rey4, Jean-Luc Malo2 and Amélie Forget2
Aim: To investigate whether the maternal use of different doses of inhaled corticosteroids (ICSs) during the first trimester of pregnancy for the treatment of asthma increases the risk of congenital malformations in the offspring.
Methods: From the linkage of three administrative Canadian databases, a cohort of 4561 pregnancies from women with asthma who delivered between 1990 and 2000 was reconstructed. A two-stage sampling cohort design was used to acquire additional data from the woman’s medical chart. Cases of congenital malformation were identified from the medical services database or the hospital database. Using refill patterns of medications, the average daily dose of ICSs used during the first trimester was calculated and categorised as follows: 0,1–500, 500–1000 and >1000 μg/day in beclomethasone–chlorofluorocarbon equivalent. A Generalized Estimation Equation model was used to estimate the adjusted odds ratio of congenital malformation as a function of ICS daily dose. All analyses were performed for all malformations and major malformations separately.
Results: Within the cohort 418 babies were identified with a congenital malformation (9.2%), 278 of which had a major malformation. About 40% of women used ICSs during the first trimester, but only 5.3% of women used >500μg/day. The adjusted odds ratio (95% CI) for all malformations associated with the use of ICSs during the first trimester was: 0.77 (0.53 to 1.13) for 1–500, 0.41 (0.19 to 0.92) for 501–1000 and 1.00 (0.42 to 2.36) for >1000μg/day. The corresponding figures for major malformations were 0.90 (0.64 to 1.24), 0.56 (0.22 to 1.43) and 1.67 (0.56 to 5.03).
Conclusion: This study adds evidence to the safety of ICSs for the treatment of asthma during pregnancy, with regard to the likelihood of congenital malformation.
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NK1/NK2 受体拮抗剂对过敏原激发的哮喘气道反应性及炎症的作用研究
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应用布地奈德福莫特罗作为缓解药物对哮喘急性加重作用的随机双盲对照研究
